Provider Demographics
NPI:1700042611
Name:SACRAMENTO VAN CONVERSIONS, INC.
Entity Type:Organization
Organization Name:SACRAMENTO VAN CONVERSIONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FIDEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:BARAJAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-381-8267
Mailing Address - Street 1:5821 FLORIN PERKINS RD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95828-1032
Mailing Address - Country:US
Mailing Address - Phone:916-381-8267
Mailing Address - Fax:916-381-1946
Practice Address - Street 1:5821 FLORIN PERKINS RD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95828-1032
Practice Address - Country:US
Practice Address - Phone:916-381-8267
Practice Address - Fax:916-381-1946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11380332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies